Re: Re:Clarify - Carol & Phylli

[Guest guest]

I'd certainly take a guess that no one with a lean of more than say 10cm or so (probably less) could get away without one or more osteotomies, but it does also depend on whether they are definitely fusing all the way to the sacrum (if only down to L3/L4, they may be able to rely a little on your ability to self compensate - not sure how much mind you without then risking those discs), and the state of your existing discs and whether they're going to be replacing them with cages or other spacers (if they're in good shape it may be difficult to restore lordosis by replacing them with spacers, if they're not then that would give more scope to restore).

The first surgeon I saw was planning a removal of the remains of my collapsed L2-3 disc and placing something there to give correction along with 2-3 small (presumably -sen) osteotomies above the anterior fused levels. The second surgeon planned to do 5-6 small osteotomies - 1-2 below the anterior fused levels and the rest above. He didn't want to go anterior again because of the risks associated.

The waiting time was similar at both hospitals, if anything worse at the one where I saw the first surgeon. By the time I was able to get the surgery I had deteriorated dramatically and the L2-3 level had fused itself, so wouldn't have been able to have the disc removal / cage placement anyway. The plan changed from the 5-6 small osteotomies to smashing the anterior fusion and doing one huge one in the midst of those levels. It also went from " yes of course we can get you upright " to the day before surgery being told " there's no way we possibly can, but we'll do our best to get you most of the way there " . That said, my case has been odd the whole way along (so far every surgeon who has seen my original xrays has given a reaction along the lines of " who on earth did that " and despite QMC being a teaching hospital and having one of the largest spine clinics in Europe, they didn't know what type my anterior rod is and no one has ever seen anything quite like what happened to me) - I'd had a stable 34° kyphosis over the length of the fusion for the 7 years since original surgery and then in the space of weeks everything collapsed to the point that it then extended over the 2 vertebrae below as well and went up to about 50° - again, pretty unexpected to say the least!

I would also hazard to say that if you've got a shorter fusion (well, one that doesn't extend so far into the lumbar region) and haven't had much if any autofusion of the levels below, it might be possible to have a significant lean being largely due to disc degeneration and or stenosis, so that while the lean would have a " fixed " portion due to the rods above, a lot of it would be postural - so again would not necessarily require osteotomies but rather decompression and fixation with most of the correction coming from using the natural flexibility of the remaining segments to pull back. That's just guesses admittedly, but seems to make sense to me ;o)

titch-- The wages of sin are death, but by the time taxes are taken out, it's just sort of a tired feeling - a Poundstone